Trait Anhedonia in Schizophrenia: A Systematic Review and Comparative Meta-analysis

Abstract

Anhedonia, the reduced capacity to experience pleasure, has long been considered a prominent feature of schizophrenia spectrum disorders. Many domain-specific conceptualizations of anhedonia and pleasure capacity have been developed, and there currently exist a variety of self-report assessment tools that purport to assess these various domains. The current systematic review and meta-analysis (PROSPERO: CRD42020156169) aimed to quantify overall and domain-specific self-reported anhedonia in people with schizophrenia compared to nonpsychiatric controls. We performed a literature search of PsycINFO, MEDLINE, and Embase databases for dissertations and peer-reviewed articles published in English prior to June 2021. Studies employing a psychometrically validated self-report measure of anhedonia, pleasure experience or affect in people with schizophrenia, schizoaffective, or schizophreniform disorders; studies utilizing at least one clearly defined healthy or community control group for comparison; and studies providing sufficient data to calculate effect sizes were included in this review. Random and mixed effects meta-analyses, meta-regressions, and subgroup comparisons were run across domains of anhedonia to explore weighted mean effect sizes and their associated moderators. In total, 146 studies met inclusion criteria, yielding 390 Hedges’ g effect sizes from the included comparisons. People with schizophrenia reported moderate-to-large elevations in overall and domain-specific anhedonia. A sensitivity analysis accounting for high risk of bias studies did not significantly impact results. Lastly, patient sex, education, negative symptom severity, antipsychotic class, and trait negative affect differentially moderated effect sizes across domains of anhedonia. Despite the heterogeneity inherent in schizophrenia spectrum disorders, self-reported anhedonia is ubiquitously reported across self-report measures in this population.

A systematic review of the application of experience sampling methodology to measure anhedonia in psychiatry and mental health

“…Overall, findings from this review indicate that anticipatory anhedonia may manifest as a state-like construct across a range of disorders. These findings extend prior conceptualizations of anticipatory anhedonia as a trait, particularly in the context of negative symptoms in schizophrenia (Krzyzanowski et al, 2022). However, most ESM studies explored anticipated pleasure or prospection, that is, the ability to anticipate experiences of pleasure in the future.…”

“…These characteristics reflect the conceptualization and typical assessment of psychotic disorders and depression. For example, anticipatory/consummatory anhedonia and social impairments are considered part of the negative symptom continuum in schizophrenia-spectrum disorders (Krzyzanowski et al, 2022), and reduced ability to feel pleasure (in general) is emphasized in depression (APA, 2022). We also found considerable heterogeneity in items that ostensibly assessed the same or similar anhedonia construct, and that patterns of results depended on how anhedonia was being measured and the specific contexts being explored.…”

“…Depression is associated with impairments in the consummatory phase, more consistent with a generalized hedonic deficit, whereas schizophrenia is associated with impairments in the anticipatory phase, more consistent with cognitive alterations or amotivation/apathy, although these findings are inconsistent (e.g., Aldridge-Waddon et al, 2020;Halahakoon et al, 2020;Hallford & Sharma, 2019;Ho & Sommers, 2013;Kieslich et al, 2022;Lambert et al, 2018;Rømer Thomsen et al, 2015; ANHEDONIA ESM REVIEW 7 Shankman et al, 2014). Recent meta-analyses found elevated levels of overall and contextspecific trait anhedonia (i.e., habitual or gestalt views of experiences) in schizophrenia compared to controls, with individuals with schizophrenia and depression both showing difficulties in social rewards but only depressed individuals showing difficulties in physical rewards (Gandhi et al, 2022;Krzyzanowski et al, 2022). Other reviews found consistent social withdrawal across disorders associated with social anhedonia (Barkus, 2021;Barkus & Badcock, 2019).…”

“…Given that most of these items have not been psychometrically tested or used across a range of psychopathologies, future studies should incorporate tests of validity and reliability where possible into their research designs. This approach will help to overcome limitations of existing trait and state self-report measures of anhedonia, which have been typically developed in either the depression or schizophrenia literatures (Krzyzanowski et al, 2022;Rizvi et al, 2016;Trøstheim et al, 2020), and to build an evidence-based for optimal ESM items. This approach aligns with initiatives that aim to improve ESM measurement in the social sciences (e.g., Measurement is the New Black Consortium, Finally, to date, few studies have assessed anhedonia using cross-sectional self-reports, lab-based experiments (behavioral, neural), and ESM in combination (for exceptions, see Bakker et al, 2019;Culbreth et al, 2020;Hooker et al, 2014;Murray et al, 2022;Webb et al, 2023).…”

Esquizofrenia: manifestações clínicas e as principais comorbidades, uma revisão sistemática

“…Diversos fatores moderadores foram identificados, como sexo, educação, gravidade dos sintomas negativos e classe de antipsicóticos. Embora exista heterogeneidade nos transtornos do espectro da esquizofrenia, a anedonia autorrelatada é consistentemente descrita nesta população, destacando sua importância clínica e a necessidade de compreensão mais aprofundada para o desenvolvimento de tratamentos mais eficazes (Krzyzanowski. et al;.…”